Abstract

Background

The focus of locally advanced (LA) and recurrent and/or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) therapy has recently shifted to the molecular level. Although the clinical effectiveness of novel therapeutics has been discussed extensively, the experience with cost-effectiveness analyses (CEAs) of targeted agents is limited. The objective of this study was to systematically review CEAs of molecular therapeutics in LA and R/M SCCHN.

Methods

A systematic literature review was performed focusing on CEAs of molecularly targeted therapeutics in LA and R/M SCCHN using MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED) and the Tufts CEA Registry. Studies were screened according to a priori eligibility criteria. Two independent reviewers appraised the studies using published criteria by Philips et al. to assess the quality and methodology of decision analytic models.

Results

A total of four studies and eight CEAs met the inclusion criteria. All CEAs were conducted from the perspective of the health care sector. Country-specific costs were applied. Efficacy data for LA and R/M patients were obtained by the Bonner (Bonner et al.) and the EXTREME (Vermorken et al.) trials, respectively. Lifetime horizon and discounting were considered. The incremental cost-effectiveness ratios of combination therapy with cetuximab ranged from likely to be cost-effective in LA patients (€8,135-€30,691/quality-adjusted life year (QALY) gained) to unlikely to be cost-effective in R/M patients (€158,060/QALY gained). The most influential variable was the cost of cetuximab. Critical assessment of the CEAs revealed that decision analytic models varied in quality and methodology. Type of sensitivity analysis, justification of preferred methods, transparency and credibility were key areas in which differences were evident.

Conclusions

Well-performed CEAs suggest that cetuximab may provide good value for money in LA SCCHN patients. Critical review of existing CEAs helps to improve the quality of forthcoming studies. Future research in LA and R/M SCCHN should explore the optimal role of molecularly targeted agents in daily practice.